The Hawaii Healthy Start Program (HSP) is a home visiting program that is intended to prevent child abuse and neglect in the first three years of children’s lives by improving the functioning of at-risk families. Mothers of new born children are screened and if found to be at risk for child abuse and neglect, are invited to enroll in the program. Families that enroll in the program receive home visits by trained paraprofessionals, who provide parenting education, model effective parent-child interaction, and ensure that each child has a primary care physician. Participation was low. The only statistically significant impact found was that mothers who participated in the program were less likely to report neglectful behaviors than mothers who did not participate. There were no differences in any measures for child abuse and neglect. No statistically significant differences were found for maltreatment, substantiated Child Protective Services (CPS) report rates, or hospital admissions for trauma.
DESCRIPTION OF PROGRAM
Target population: families assessed as at-risk of child abuse at the time of their children’s births
The Hawaii Healthy Start Program (HSP) is a home visiting program targeted at families at-risk of child abuse and neglect. HSP is intended to prevent child abuse and neglect, and promote child health and development in the first three years of children’s lives by improving the functioning of at-risk families. The HSP model has two parts: 1) population-based screening and assessment to identify families at-risk of child abuse and neglect, and 2) home visiting of identified at-risk families. The model specifies that home visiting be provided for three to five years, starting with weekly visits by trained paraprofessionals with at least a high school diploma. As families achieve milestones in healthy functioning, home visits become less frequent, moving from weekly to bi-weekly to monthly to quarterly. HSP is administered by the Hawaii State Department of Health and community agencies provide screening and assessment in target communities. A single agency provides the five-week core training to all home visitors. The HSP start training manual and training materials are available. In 1998, seven community agencies operated fourteen HSP sites statewide, with a budget of more than $6 million.
EVALUATION OF PROGRAM
Evaluated Population: A total of 730 families participated in the evaluation. Requirements included the ability to be interviewed in English. The HSP and control groups were comparable on demographic variables at baseline except that partner violence was statistically significantly more common in the control group. The average maternal age was 23 years old, more than sixty percent of households were below the poverty level, and about one-quarter of the mothers were married. One third of the mothers were Native Hawaiian or Pacific Islanders, slightly more than a quarter were Asian or Filipino, and a quarter had no primary ethnicity or their ethnicity was unknown.
Approach: Participants were randomly assigned to three study groups: those who participated in HSP (n=395), a control group that completed only a baseline and post test so as to allow a check for the influence of multiple tests (n=45), and a control group that was followed at one, two, and three years (n=290). Seventy-six percent of eligible families completed baseline interviews either in the hospital after giving birth or soon thereafter at home, and became study participants. Data were collected through interviews with the mothers, reviews of each child’s primary care records, and from substantiated Child Protective Services (CPS) reports of child abuse or neglect. Data included maternal reports of parenting behaviors, observed parenting behaviors, hospitalizations, maternal relinquishment of primary caregiver role, substantiated CPS reports (excluding those based on toxicology screens at the time of the child’s birth), and dose of service. Half of the families dropped out of the program by the end of the first year and home visiting frequency was substantially lower than intended. The study examined overall program impact for thirty-five measures, as well as for ten subgroups, and adjusted for dose of service.
Results: The main finding of this study was that HSP did not prevent child abuse or promote use of nonviolent discipline, but did have a modest impact on preventing neglect: HSP mothers were statistically significantly less likely to report neglectful behaviors (Beta=0.72).No statistically significant differences were found for maltreatment, substantiated CPS report rates, or hospital admissions for trauma.
SOURCES FOR MORE INFORMATION
Hawaii Family Stress Center. (1991). The Healthy Start training manual. Honolulu, HI: Hawaii Family Stress Center.
Hawaii Family Stress Center. (1995). The Healthy Families America family support worker training materials. Honolulu, HI: Hawaii Family Stress Center.
Duggan, A., McFarlane, E., Fuddy, L., Burrell., L. Higman, S. M., Windham, A., Sia, C. (2004). Randomized trial of a statewide home visiting program: impact in preventing child abuse and neglect. Child Abuse & Neglect, 28, 597-622.
Duggan, A. K., McFarlane, E. C., Windham, A. M., Rohde, C. A., Salkever, D. S., Fuddy, L., Rosenberg, L. A., Buchbinder, S. B., Sia, C. C. J. (1999). Evaluation of Hawaii’s Healthy Start Program. The Future of Children, 9, 66-89.
KEYWORDS: Infants (0-12 mos), Toddlers (12-36 mos), High-Risk, Home-based, Home Visitation, Child Maltreatment, Parent-Child Relationship
Program information last updated 5/27/2014.